What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services?Deborah Jane Russell A B D , John Wakerman A C and John Stirling Humphreys A B
A Centre of Research Excellence in Rural and Remote Primary Health Care, PO Box 666, Bendigo, Vic. 3552, Australia.
B Office of Research, School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. Email: email@example.com
C Centre for Remote Health, Flinders University and Charles Darwin University, PO Box 4066, Alice Springs, NT 0871, Australia. Email: firstname.lastname@example.org
D Corresponding author. Email: email@example.com
Australian Health Review 37(2) 256-261 https://doi.org/10.1071/AH12184
Submitted: 17 May 2012 Accepted: 15 October 2012 Published: 18 March 2013
Background. Optimising retention of rural and remote primary healthcare (PHC) workers requires workforce planners to understand what constitutes a reasonable length of employment and how this varies. Currently, knowledge of retention patterns is limited and there is an absence of PHC workforce benchmarks that take account of differences in geographic context and profession.
Methods. Three broad strategies were employed for proposing benchmarks for reasonable length of stay. They comprised: a comprehensive literature review of PHC workforce-retention indicators and benchmarks; secondary analysis of existing Australian PHC workforce datasets; and a postal survey of 108 rural and remote PHC services, identifying perceived and actual workforce-retention patterns of selected professional groups.
Results. The literature review and secondary data analysis revealed little that was useful for establishing retention benchmarks. Analysis of primary data revealed differences in retention by geographic location and profession that took time to emerge and were not sustained indefinitely. Provisional benchmarks for reasonable length of employment were developed for health professional groups in both rural and remote settings.
Conclusions. Workforce-retention benchmarks that differ according to geographic location and profession can be empirically derived, facilitating opportunities for managers to improve retention performance and reduce the high costs of staff replacement.
What is known about the topic? Health services located in small rural and remote locations are likely to continue to experience workforce shortages and high costs of recruitment. Health workforce retention is therefore crucial. However, effective rural health workforce planning and use of strategies to maximise retention of existing health workers is hindered by inadequate knowledge about baseline employment-retention patterns.
What does this paper add? Differences in health worker retention patterns by geographic location and profession are most evident after the first 6 months through until the end of the second year of employment. Health worker-retention benchmarks that differ according to geographic location and profession are proposed.
What are the implications for practitioners? Benchmarking workforce retention in comparable health services can enable identification of best practice and the underpinning retention strategies. Workforce planners can use this, together with knowledge of baseline retention patterns and the high cost of staff replacement, to guide the design, timing and implementation of cost-neutral retention strategies.
Additional keywords: Aboriginal health workers, allied health, benchmark, costs, costs analysis, doctors, managers, nurses, retention, workforce.
References Productivity Commission. Australia’s Health Workforce. Productivity Commission Research Report. Canberra: Commonwealth of Australia; 2005. Available at http://www.pc.gov.au/projects/study/health-workforce/docs/finalreport [verified 7 May 2012].
 Buykx P, Humphreys J, Wakerman J, Pashen D. Systematic review of effective retention incentives for health workers in rural and remote areas: towards evidence-based policy. Aust J Rural Health 2010; 18 102–9.
| Systematic review of effective retention incentives for health workers in rural and remote areas: towards evidence-based policy.CrossRef |
 Health Workforce Australia. Health Workforce 2025 - Doctors, Nurses and Midwives - Volume 1. Adelaide: 2012. Available at https://www.hwa.gov.au/health-workforce-2025 [verified 7 May 2012].
 World Health Organization. Improving Health Worker Performance: In Search of Promising Practices. Geneva: WHO; 2006. Available at http://www.who.int/hrh/resources/improving_hw_performance.pdf [verified 7 May 2012].
 Arnold E. Managing human resources to improve employee retention. Health Care Manag (Frederick) 2005; 24 132–40.
 Fang YQ. Turnover propensity and its causes among Singapore nurses: an empirical study. Int J Hum Resour Manage 2001; 12 859–71.
 Humphreys JS, Wakerman J, Wells R, Kuipers P, Jones J, Entwistle P, et al. Improving primary health care workforce retention in small rural and remote communities - How important is ongoing education and training. Canberra: Australian Primary Health Care Research Institute; 2007. Available at http://aphcri.anu.edu.au/content/stream-six-workforce/improving-primary-health-care-workforce-retention-small-rural-and-remote [verified 7 May 2012].
 Waldman JD. Change your metrics: if you get what you measure, then measure what you want - retention. J Med Pract Manage 2006; 22 13–9.
 Waldman JD, Arora S. Measuring retention rather than turnover: a different and complementary HR calculus. Human Resour Plan 2004; 27 6–9.
 Russell DJ, Humphreys JS, Wakerman J. Russell DJ, Humphreys JS, Wakerman J. How best to measure health workforce turnover and retention: five key metrics. Aust Health Rev 2012; 36 290–295.
 Camp RC, Tweet AG. Benchmarking applied to health care. Jt Comm J Qual Improv 1994; 20 229–38.
 National Health and Hospital Reform Commission. Beyond the blame game: accountability and performance for the next Australian Health Care Agreements. Canberra: NHHRC; 2008. Available at http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/504AD1E61C23F15ECA2574430000E2B4/$File/BeyondTheBlameGame.pdf [verified 7 May 2012].
 National Rural Health Alliance. Rural health information papers. Best practice for rural and remote health services. Canberra: NRHA; 1997. Available at http://nrha.ruralhealth.org.au/cms/uploads/publications/rhip1.pdf [verified 7 May 2012].
 National Health Ministers’ Benchmarking Working Group. First national report on health sector performance indicators. Canberra: 1996. Available at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454193 [verified 7 May 2012].
 Australian Institute of Health and Welfare. Rural, regional and remote health. Information framework and indicators. Version 1. AIHW cat. no. PHE 44. Canberra: 2003. Available at http://www.aihw.gov.au/publication-detail/?id=6442467477 [verified 7 May 2012].
 Australian Institute of Health and Welfare. Rural, regional and remote health. Information framework and indicators. Version 1b. Rural Health Series Number 6. AIHW cat. no. PHE 69. Canberra: 2005. Available at http://www.aihw.gov.au/publication-detail/?id=6442467780 [verified 7 May 2012].
 Health Workforce Australia. Aboriginal and Torres Strait Islander health worker project: Interim Report. Adelaide: 2011. Available at https://www.hwa.gov.au/sites/uploads/atsihw-project-interim-report-20111017.pdf [verified 7 May 2012].
 Keane S, Smith T, Lincoln M, Fisher K. Survey of the rural allied health workforce in New South Wales to inform recruitment and retention. Aust J Rural Health 2011; 19 38–44.
| Survey of the rural allied health workforce in New South Wales to inform recruitment and retention.CrossRef |
 Humphreys JS, Wakerman J, Kuipers P, Wells B, Russell D, Siegloff S, et al. Improving workforce retention: developing an integrated logic model to maximise sustainability of small rural & remote health care services Canberra: Australian Primary Health Care Research Institute; 2009. Available at http://aphcri.anu.edu.au/research-program/aphcri-network-research-completed/stream-twelve-extension-funding-workforce/improving-workforce [verified 7 May 2012].
 Humphreys JS, Wakerman J, Pashen D, Buykx P. Retention strategies and incentives for health workers in rural and remote areas: what works? Canberra: Australian Primary Health Care Research Institute; 2009. Available at http://aphcri.anu.edu.au/research-program/aphcri-network-research-completed/stream-sixteen-rapid-response-projects/retention-strategies-and [verified 7 May 2012].
 Department of Primary Industries and Energy. Rural, Remote and Metropolitan Areas Classification 1991 Census Edition. Canberra: Australian Government Publishing Service; 1994. Available at http://www.pc.gov.au/__data/assets/pdf_file/0004/45724/subdr096.pdf [verified 7 May 2012].
 Collett D. Modelling survival data in medical research. London: Chapman & Hall/CRC; 2003.
 Garnett S, Coe K, Golebiowska K, Walsh H, Zander K, Guthridge S, et al. Attracting and Keeping Nursing Professionals in an Environment of Chronic Labour Shortage: A Study of Mobility Among Nurses and Midwives in the Northern Territory of Australia. Darwin: Charles Darwin University Press; 2008. Available at http://cdupress.cdu.edu.au/books/documents/NTnurseandmidwifeturnover.pdf [verified 7 May 2012].
 Chisholm M, Russell D, Humphreys J. Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs? Aust J Rural Health 2011; 19 81–8.
| Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs?CrossRef |
 Doiron D, Jones G. Nurses’ retention and hospital characteristics in New South Wales. Econ Rec 2006; 82 11–29.
| Nurses’ retention and hospital characteristics in New South Wales.CrossRef |